Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2014-00043
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2014
Parcel: 1 S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 212
Project: Miadonna Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Relocating(2)and adding(3)sprinkler heads for TI.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/27/2014 $53.78
12%State Surcharge-Building 02/27/2014 $6.45
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 225
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $60.23
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $600.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 o
Issued By: - 'e mittee Signature: raitif
Agioler
Call .4175 by 7:00 a.m.for the next available inspe ', date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
_ Received
City of Tigard .� Date/B : a.. �7 Ji• • Permit No.: —
13125 SW Hall Blvd.,Tigard,OR 97223 0 \\t Plan Review
I Phone: 503.639.4171 Fax: 503.598.1960 'LI Date/B : Other Permit: '
TI G A R D Inspection Line: 503.639.4175 $ A 2.0k Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov Va 411 Notified/Method: ! Supplemental Information
TYP Gv REQUIRED DATA 1-AND 2-FAMILY DWELLING
❑New construction ❑Detttortion'_ Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-and 2-family dwelling Valuation:
0 Commercial/industrial
ID Accessory building 12 Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10250 SW Greenburg Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97233 Garage/carport area: square feet
Suite/bldg./apt.no.:212 Project name:Mia Donna Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map parcel no: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ '
Relocate two(2)and add three(3)fire sprinkler heads. lnC�tl
Existing building area: square feet
McKinstr Job#71379 New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
Name:MiaDonna Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( 1 New:
0 APPLICANT ® CONTACT PERSON
NOTICE
Business name:McKinstry Company,LLC All contractors and subcontractors are required to be
Contact name:Antonija Krizanac licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16790 NE Mason Street,Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97230 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)278.3971 Fax::(503)331.6907
E-mail:antonijak @mckinstry.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:McKinstry Company,LLC (Please refertof4a chedule)
Permit fee:
Address:Same as applicant
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lie.: 172811 Total permit fees:
Amount received: Ao,
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Antonija Krizanac Date: (PI;t j/ i within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
C\Building\Permits\FPS-PermitApp.doc 03/23/06 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only
❑ Addition Z 1-10 heads: No plan review required.
® Alteration ❑ 11+heads: Plan review required.
El Repair
Number of sprinkler heads: 5
Additional description of work
Type of System (Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group Light
Density . 10
desigta_areaS9vsAkk✓c- ads
K.Factor 5.6
Sprinkler Project Valuation: $ 600
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm .,4- 1.
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal(see A,B &C above): $ 600
Permit fee based on project valuation(see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $ 600
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer,or NICET level"3" technicians.
\\nicldnstry\ponland\Construction\Projects\705 OR SPG Hard Cards\2014\71379 Miponna\Pernik\71379-FP Permit Application.doc
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10250 SW GREENBURG RD 212, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler Final
2014-03-21 00:00:00
FPS2014-00043
PASS - No C of O
Violation Summary:
Inspector Contractor